10-1034589110,
:::::::.::::::: OPERMIT
Federal WayRrM1 CO ME PL DE EN/0 - / 6 3 FP
t(,,N,l~DF�.F���PMENTSERti.,C �I�'' APPLICATION IVSD
2.53-85.5-2607•FAX 253-8 15-260
' eICtS CUG 1 2C..j
�r 5rA I�y
SITE ADDRESS I C— ®• 'b SUITE/UNIT#
?7 St I JM Y So . cosERA L W y > 1 1
( PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
'.71kill a-O
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING FIRE PREVENTION
NAME OF PROJECT
s /� tvv l
(Tenant Name/Homeowner Last Name) I,,4{. ;�:• b C
PROJECT DESCRIPTION ` nAO_
Detailed description of work to T V — ` 1 Pd/��U� � r k Yat= /4(--fAiR—Vk
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER W 14-
- ZA-*
b ?/ 'D +e S
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME/ ... -. _// PHONE
vl'(I'I lL LVr'l-1-1
.. 'tC.l.)mil'Lui�la;14-tGA4S j (v56d5-2_ (US-D
MAILIN ADDRES JJ
CONTRACTOR v � � yAg 5y(ite-441Spe �gS
CIr t j -(z v s(/3/\ ZIP .223 FAX
a-6762.--tizk-i CCP(A'
WA STATE,tn RACTO 'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME•---7---. i PHONE _
(The individual to receive and �� �� q Z5 S v ,-(Ci i 3
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5 000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arise ou the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city pa of this application.
1
SIGNATURE: /y7'L4) DATE C5N A U
PRINT NAME: /2u
Bulletin#100—April 14,2010 r( Page 1 of 3 k:\Handouts\Penmit Application
• •
VALUE OF MECHANICAL WORK (a copy of bid or estimate md A
Indicate how many of each type of fixture to be installed or relocated as part of this projeo de e,�res�remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) _.
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial)_
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST '
DUCTING GAS PIPING WOODSTOVES
.......................::..:...:.....::...,............ .r:.:. ...........;......,.... ....4:.....;,.:...,...:............{.,:.fr•::f>i i5iii:'ii::�iiii}'•}}:•:�•}:•}'•:�i:?:::>}>:�>:;�}::�>:�}<�:� ?�}`::•}}:;.:;.>:>:.;:'}::':'i•'ii
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........................................................ .:.r.. ............::::.::::. -}i:-::•,. •'• - •` '•::' •':: i':? '• ''•:i::'i':isti:::::::...............................:./.......:v.:v-:w::•-::?w.�.�...
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINAL / OTHER(Describe)
DRAINS SHOWERS VACU BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) W R HEATERS(uectricl
HOSE BIBBS SUMPS ASHING MACHINES :}:•}: YI' f ?(
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEP/Eye/PURVEYOR VALUE OF EXISTING IMPROVEMENTS.
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes❑ No ❑ Yes ❑ No
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AREA DESCRIPTION(in square feet) EXI TING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
::4iiz:<r:i23i�i:� ;.`•f::;<` `:: �i� :i �:::�i£{:ii�:�a`t
COVERED ENTRY
GARAGE 0 CARPORT ❑
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EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING P CE$ 1 # OF BEDROOMS
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Area Construction #of
AREA DESCRIPT •N Occupancy Group(s) Additional Information
in Square Feet Type Stories
ADDITI•
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Area Construction #of
AREA DES••IPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
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TENANT AREA ONLY
Bulletin#100—April 14,2010 Page 2 of 3 k:\Handouts\Permit Application